Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions:a meta-analysis

To the Editor:Acute large vessel occlusion(LVO)is responsible for most acute ischemic stroke(AIS),a common cause of disability and death worldwide.Randomized controlled clinical trials(RCTs)provided evidence endorsing intravenous thrombolysis(IVT,also termed bridging therapy[IVT])and endovascular thrombectomy over IVT alone as the current standard treatment for people with LVO in the anterior circulation.[1]The current American and European guidelines recommend using IVT for all eligible individuals with LVO before direct mechanical thrombectomy(d-MT)(class of recommendation-I).Recent RCTs suggest that MT was noninferior to BT in terms of efficacy and safety,[2,3]which contradict the results from multiple meta-analyses favoring BT over d-MT.[4]The benefit of routine IVT for eligible individuals before thrombectomy has become controversial.BT is associated with complications,including the risk of vasospasm,distal emboli,or symptomatic intracranial hemorrhage.

Seizures in posterior reversible encephalopathy syndrome:blood pressure management in normotensive patients

Posterior reversible encephalopathy syndrome(PRES)is a rare clinical disease that refers to the subcortical vasogenic edema involving bilateral parieto-occipital regions,with a usually reversible syndrome when causes are eliminated or controlled.Hypertension or blood pressure fluctuations are most common causes of PRES,but other contributors like chemotherapy and autoimmune disorders have also been reported.PRES has rapid onset of symptoms.Therefore,it is of major importance to determine whether blood pressure management plays an important role in prognosis.We presented two PRES patients who developed non-convulsive seizure but had normal baseline blood pressure at the time of presence of cause.The diagnosis of PRES was made by neurologists.The patients had no history of seizure or hypertension,but during the disease course they presented with temporal elevation of blood pressure with different durations.The second patients without instant blood pressure control developed residual symptoms of seizure at 90-and 120-day follow-up.Although the exact pathophysiology of PRES remains to be fully understood,primary and secondary prolonged blood pressure fluctuations may be associated with the prognosis of this syndrome.Early blood pressure management would be critical to favorable outcome.